REPUBLIC DU CAMEROUN REPUBLIC OF CAMEROON

Paix-Travail-Patrie Peace-Work-Fatherland
------------ ------------
MINISTERE DE MINISTERE DE
L’ENSIGNEMENT SUPERIEUR L’ENSIGNEMENT SUPERIEUR
------------- -------------
COMMISSION NATIONALE d’ORGANISATION DES EXAMENS NATIONAL COMMISSION FOR THE ORGANISATION OF THE
DU HND HIGHER NATIONAL DIPLOMA (HND) EXAM
NATIONAUX

HIGHER NATIONAL DIPLOMA (HND) EXAM

Specialty/Option: Medical Paper: Medical Microbiology and Parasitology
Bacteriology/Virology Medical
Parasitology/Mycology Medical Entomology

Code Nature of Paper Duration Credit value Total

MLS 19 Written 03hrs 4 100

ATTEMPT ALL QUESTIONS

PART A : MULTIPLE CHOICE (MCQs ) 30mks, 1 mk each

1. The initial step in the process of many bacterial infections is adherence of the organism to
mucous membranes. The bacterial component that mediates adherence is the:
(A) Lipid A
(B) Nucleoid
(C) Peptidoglycan
(D) Pilus
(E) Plasmid

2. Mycobacterium tuberculosis stains well with the acid-fast stain, but not with the Gram stain.
Which one of the following is the most likely reason for this observation?
(A) It has a large number of pili that absorb the purple dye.
(B) It has a large amount of lipid that prevents entry of the purple dye.
(C) It has a very thin cell wall that does not retain the purple dye.
(D) It is too thin to be seen in the Gram stain.
(E) It has histones that are highly negatively charged.

3. Bacteria that cause nosocomial (hospital-acquired) infections often produce extracellular

substances that allow them to stick firmly to medical devices, such as intravenous catheters.
Which one of the following is the name of this extracellular substance?
(A) Axial filament
(B) Endotoxin
(C) Flagella
(D) Glycocalyx
( E) Porin
4. The emergence of antibiotic-resistant bacteria, especially in enteric gram-negative rods, is a
medically important phenomenon. This most commonly occurs by a process that involves a sex
pilus and the subsequent transfer of plasmids carrying one or more transposons. Which one of
the following is the name that best describes this process?
(A ) Conjugation
( B ) Transduction
( C ) Transformation
( D ) Translocation
( E ) Transposition

5. Vertical transmission is the transmission of organisms from mother to fetus or newborn child.
Infection by which one of the following bacteria is most likely to be transmitted vertically?
(A ) C hlamydia trachomatis
( B ) C lostridium tetani
( C ) H aemophilus influenzae
(D ) S higella dysenteriae
(E ) S treptococcus pneumonia

6. If the venipuncture site is inadequately disinfected, blood cultures are most often contaminated
with which one of the following bacteria?
(A ) Escherichia coli
(B ) H aemophilus influenzae
(C ) P seudomonas aeruginosa
(D ) S taphylococcus epidermidis
(E ) S treptococcus pneumonia

7. The susceptibility of bacteria to an antibiotic is often determined by using the minimal

inhibitory concentration (MIC) assay. Regarding the MIC assay, which one of the following is
the most accurate?
(A) MIC is the lowest concentration of the bacteria isolated from the patient that inhibits the
activity of a standard dose of antibiotic.
(B) MIC is the lowest concentration of antibiotic that inhibits the growth of the bacteria isolated
from the patient.
(C) MIC is the lowest concentration of antibiotic that kills the bacteria isolated from the patient.
( D) MIC is the lowest concentration of antibiotic in the patient’s serum that inhibits the activity
of a standard dose of antibiotic.

8. Which one of the following sets consists of bacteria, both of which are anaerobes?
(A) Actinomyces israeli and Serratia marcescens
(B) Campylobacter jejuni and Vibrio cholerae
(C) Clostridium perfringens and Bacteroides fragilis
(D) Mycobacterium tuberculosis and Pseudomonas aeruginosa
(E) Mycoplasma pneumoniae and Corynebacterium diphtheriae
9. An outbreak of serious pneumococcal pneumonia and sepsis among inmates in an
overcrowded prison has occurred. Laboratory analysis determined that one serotype was
involved. The prison physician said that the pneumococcal vaccine might have limited the
outbreak. Which one of the following structures of the pneumococcus is responsible for
determining the serotype and is also the immunogen in the vaccine?
(A) Capsule
(B) Flagellar protein
(C) O antigen
(D) Peptidoglycan
(E) Pilus protein

10. Which one of following laboratory tests is the most appropriate to distinguish Streptococcus
pyogenes from other Alpha-hemolytic streptococci?
(A) Ability to grow in 6.5% NaCl
(B) Activation of C-reactive protein
(C) Hydrolysis of esculin in the presence of bile
(D) Inhibition by bacitracin
(E) Inhibition by optochin

11. 20-year-old sexually active woman reports dysuria and other symptoms of a urinary tract
infection. Gram stain of the urine reveals gram-positive cocci. Which one of the following set of
bacteria are most likely to cause this infection?
(A) Staphylococcus aureus and Streptococcus pyogenes
(B) Staphylococcus saprophyticus and Enterococcus faecalis
(C) Streptococcus agalactiae and Staphylococcus epidermidis
(D) Streptococcus pneumoniae and Enterococcus faecalis
(E) Streptococcus pyogenes and Streptococcus pneumonia

12. Regarding the differences between Neisseria meningitidis (meningococci) and Neisseria
gonorrhoeae (gonococci), which one of the following is the most accurate statement?
(A) Humans are the reservoir for both organisms.
(B) Many clinical isolates of meningococci produce B-lactamase, but clinical isolates of
gonococci do not.
(C) Meningococci have multiple antigenic types, but gonococci have only one antigenic type.
(D) The conjugate vaccine against gonorrhea contains seven types of the pilus protein as the
immunogen.
(E) The main mode of transmission for both organisms is respiratory droplets.

13. Identify which of the following properties can be used to distinguish Staphylococcus aureus
from other potentially pathogenic staphylococci:
A Coagulase
B DNAase
C Protein A
D Haemolysins
E Toxic shock syndrome toxin (TSST)
14. Which two statements about Helicobacter are incorrect?
A Helicobacter pylori is the most common cause of duodenal ulceration and gastric cancer.
B Infection with Helicobacter pylori occurs commonly in early childhood and usually becomes
chronic, often life-long.
C The prevalence of infection with Helicobacter pylori is low in countries with poor sanitation.
D Helicobacter pylori are urease positive.
E Treatment of infection often involves a proton pump inhibitor to reduce gastric acidity coupled
with one antimicrobial.

15. Which of the following statement about viruses are incorrect?

A They are icosahedral, helical or more complex in shape.
B They all contain DNA.
C Viral nucleic acids can be single- or double- stranded, circular or linear, and have negative or
positive polarity.
D They are obligate intracellular parasites and can be grown in cell culture.
E Viral infection is always diagnosed by direct detection of all or part of the virus.

16. Which of the following methods are used for the direct detection of viruses?
A Polymerase chain reaction.
B Direct immunofluorescence.
C Electron microscopy.
D Complement fixation test.
E Enzyme-linked immunosorbent antibody detection.

17. The incubation period of a viral infection is (select one correct answer):
A The time from acquisition of a virus to the resolution of symptoms.
B The time from onset of symptoms to resolution of symptoms.
C The time from acquisition of a virus to the onset of symptoms.
D The time it takes to cultivate a virus in the laboratory.
E The period during which an infected patient can transmit the virus.

18. Which two of the following statements about Herpesviruses are incorrect?
A Herpesviruses are non-enveloped, double stranded DNA viruses.
B Following infection, a latent infection that persists for life is established.
C Herpes simplex virus (HSV) is spread mainly via sexual activity.
D Varicella-Zoster virus (VZV) is the cause of glandular fever (‘infectious mononucleosis’).
E Recurrent infection with Cytomegalovirus (CMV) is common in immunocompromised
patients, following solid organ or stem cell transplants.

19. Which three of the following statements about these retroviruses are incorrect?
A They are single stranded RNA enveloped viruses.
B Transmission of the Human Immunodeficiency virus (HIV) and Human T-cell lymphotropic
viruses (HTLV) is mainly through the faecal-oral route.
C Infection with HIV and the development of AIDS is characterised by profound
immunosuppression and infection with a variety of microorganisms.
D No antiretroviral drugs are available for the treatment of infection with HIV.
E A minority of people infected with HTLV-1 may develop adult T-cell leukaemia or
lymphoma.

20. Which of the following statements about yeasts are incorrect?

A Most cryptococcal infections occur in immunocompetent individuals.
B Cryptococcal species have polysaccharide capsules that can be visualised by mixing fluid
specimens with Indian ink.
C Candida albicans is a commensal of the mouth and gastrointestinal tract.
D Cryptococcal species are the cause of ‘thrush’.
E Malassezia furfur is the cause of pityriasis versicolor, which results in scaly skin and
depigmentation.

21. Which of the following statements concerning Toxoplasma gondii is incorrect?

A Human infection can result from ingestion of the microorganism as cysts contained in cat
faeces and undercooked meat.
B It can cause a glandular fever-like syndrome in immunocompetent hosts.
C It causes serious conditions, including myocarditis, choroidoretinitis and meningoencephalitis
in immunocompromised hosts.
D It can be reactivated by immunosuppression.
E No serological tests are available to aid diagnosis.

22. A protozoan with characteristic jerky motility is most commonly observed in

a. Vaginal secretions
b. Duodenal contents
c. Blood
d. Biopsied muscle
e. Sputum

23. Regarding Entamoeba histolytica, which one of the following is most accurate?
(A) E. histolytica causes “flask-shaped” ulcerations in the colon mucosa.
(B) Domestic animals such as dogs and cats are the main reservoir of E. histolytica.
(C) In the microscope, E. histolytica is recognized by having two sets of paired flagella.
(D) E. histolytica infections are limited to the intestinal mucosa and do not spread to other
organs.
(E) The infection is typically acquired by the ingestion of the trophozoite in contaminated food
and water.

24. Regarding Plasmodium species, which one of the following is most accurate?
(A) These organisms are transmitted by the bite of female Anopheles mosquitoes.
(B) The bite of the vector injects merozoites into the bloodstream that then infect red blood cells.
(C) Both male and female gametocytes are formed in the vector and are injected into the person
at the time of the bite.
(D) Hypnozoites are produced by Plasmodium falciparum and can cause relapses of malaria after
the acute phase is over.
(E) Malaria caused by Plasmodium vivax is characterized by a cerebral malaria and blackwater
fever more often than malaria caused by the other three species.

25. Cysticercosis is most likely to be acquired by:

(A) Drinking water contaminated with feces of an infected pig
(B) Drinking water contaminated with feces of an infected cow
(C) Drinking water contaminated with feces of an infected human
(D) Ingestion of undercooked pork from an infected pig
(E) Ingestion of undercooked beef from an infected cow

26. Which one of the following nematodes is transmitted by a filariform larva penetrating the
skin?
(A) Anisakis simplex
(B) Onchocerca volvulus
(C) Strongyloides stercoralis
(D) Toxocara canis
(E) Trichuris trichiura

27. Which of the following species of Plasmodium is responsible for malignant tertian malaria?

A Plasmodium falciparum.
B Plasmodium malariae.
C Plasmodium vivax.
D Plasmodium ovale.
E Plasmodium knowlesi.

28. Which two of the following statements about cestodes (tapeworms) are incorrect?
A They have either male or female reproductive organs.
B They can be up to 30 feet long.
C Cestodes have two reservoirs in their life cycle, one for larvae and one for adult worms.
D Pigs are the reservoir for Taenia solium larvae.
E Cows are the reservoir for Taenia saginata larvae.

29. Which of the following statements regarding Mycobacterium tuberculosis are incorrect?
A It stains well by the Gram stain.
B It can be identified in clinical samples by the ZN stain.
C It causes only chest infections.
D Associated infections need antibiotic treatment for several months.
E Infection with this microorganism can be prevented by vaccination.

30. Which of the following statements about Cholera is incorrect?

A It is caused by Vibrio cholerae.
B Associated infections are spread by the faecal-oral route.
C Animals can be host carriers of the causative microorganism.
D It has a short incubation period of 1–3 days.
E If untreated has a high related mortality.

PART B : Structural 30mks

1. Complete the table below , how will you identify the following microorganisms (10mks)
Features Staphylococcus aureus Salmonella typhi
Gram stain
Motility
Catalase
Oxidase
H2S production

2. Enlist three Measurement technique for Microbial Concentrations analysis (3mks)

3. Describe the 3 general characteristics of viruses in one sentence each (3 marks)
4. List five categories of vaccines that you know commonly use against virus. (4marks)
5. Describe three Isolation techniques with illustrations on how Microorganisms can be
obtain in a Pure Culture plating (10mks)

PART C : ESSAY 40mks

1. Discuss on the features use to carry quality control on a media (10mks)

2. Describe the gram staining technique(10mks)
3. Describe the life cycle of a malaria parasite and highlight the diagnostive stages and
infective stages of the parasite (10mks)
4. Lab using different culture systems, including cell or tissues cultures. Describe the 3
types of cell cultures that you know. (10 marks)
 MARKING GUIDE
SECTION A

1. D
2. B
3. D
4. A
5. A
6. D
7. B
8. C
9. A
10. C
11. B
12. C
13. A
14. C
15. B
16. A,B & C
 17. C
18. C, & D
19. A, B & D
20. D
21. E
22. A
23. A
24. A
25. D
26. C
27. A
28. C
29. A, & C
30. C

SECTION B: Structural

1.

Features Staphylococcus aureus Salmonella typhi

Gram stain Positive negative
Motility Non-motile Motile
Lactose utilization Negative Negative
Coagulase Positive Negative
H2S production Negative Positive

2.
 Tubidity
 Plate count
 Colorimetry methods

3. Describe the 3 general characteristics of viruses in one sentence each (3 marks)

 i) Viruses are characteristically minute to the extent that they cannot accomodate
the enzymatic mechinery to enable them have an independent free existence.
ii) Viruses are metabolically inert, and cannot replicate unless found within a living
host cell (Obligate parasitism).
iii) Viruses possess a single type of nucleic acid, which either be DNA or RNA, and it
is this which forms the basis of the genetic role of the infectivity of viruses.

4. List five categories of vaccines that you know commonly use against virus. (4marks)
:
i) Live virus vaccines
ii) Inactivated virus vaccines
iii) Sub-unit vaccines
iv) Synthetic vaccines
v) DNA vaccines

5. Isolation of Microorganisms in Pure Culture plating techniques

(i) spread plate technique

(ii) Pour plate techqique
(iii) streak-plate technique
 Pour plate technique

PART C : ESSAY 40mks

1. Discuss on the features use to carry quality control on a media (10mks)

(i) pH testing. The pH of the prepared medium need not be checked routinely when
it is correctly prepared from dehydrated powder. If the medium is prepared
from basic ingredients, it should be allowed to cool before the pH is tested. Solid
media should be tested with a surface electrode or after maceration in distilled
water. If the pH differs by more than 0.2 units from the specification, adjust
with acid or alkali or prepare a new batch.
(ii) . Sterility testing. Carry out routine sterility tests on media to which blood or other
components have been added after autoclaving. Take 3–5% of each batch and incubate
 at 35 ∞C for 2 days. Refrigerate the rest. If more than two colonies per plate are seen,
discard the whole batch.
(ii) . Performance testing. The laboratory should keep a set of stock strains for
monitoring the performance of media

2. Describe the gram staining technique(10mks)

(i) Fix smear using heat or methanol.

(ii) Cover with crystal violet stain (10–30 seconds).
(iii) Rinse with water. Do not blot.
(iv) Counterstain with Gram’s iodine stain (10–30 seconds).
(v) Rinse with water. Do not blot.
(vi) Decolorize with gentle agitation in 30% acetone-alcohol (10–30 seconds, until stain no
longer flows off slide).
(vii) Rinse with water. Do not blot.
(viii) Cover with safranin stain (10–30 seconds).
(ix) Rinse with water and air or blot dry.

3. Describe the life cycle of a malaria parasite and highlight the diagnostive stages and
infective stages of the parasite (10mks)
4, the lab using different culture systems, including cell or tissues cultures. Describe the 3 types
of cell cultures that you know. (8 marks)

i) Primary cell culture is obtained directly from the tissues or organ of an animal and
the cells have a short life span in the lab since they die after about 5-10 passages.
ii) Cell strains or secondary cell lines arse after a primary cell line is serially passaged
(over 100 times) until a particular cell type predocminates.
iii) These are transformed secondary cell lines that Have become immortal.